Cost and cost‐effectiveness analysis of pre‐exposure prophylaxis among men who have sex with men in two hospitals in Thailand

Abstract

IntroductionIn 2014, the Government of Thailand recommended pre‐exposure prophylaxis (PrEP) as an additional HIV prevention programme within Thailand's National Guidelines on HIV/AIDS Treatment Prevention. However, to date implementation and uptake of PrEP programmes have been limited, and evidence on the costs and the epidemiological and economic impact is not available.MethodsWe estimated the costs associated with PrEP provision among men having sex with men (MSM) participating in a facility‐based, prospective observational cohort study: the Test, Treat and Prevent HIV Programme in Thailand. We created a suite of scenarios to estimate the cost‐effectiveness of PrEP and sensitivity of the results to the model input parameters, including PrEP programme effectiveness, PrEP uptake among high‐risk and low‐risk MSM, baseline and future antiretroviral therapy (ART) coverage, condom use, unit cost of delivering PrEP, and the discount rate.ResultsDrug costs accounted for 82.5% of the total cost of providing PrEP, followed by lab testing (8.2%) and personnel costs (7.8%). The estimated costs of providing the PrEP package in accordance with the national recommendation ranges from US$223 to US$311 per person per year. Based on our modelling results, we estimate that PrEP would be cost‐effective when provided to either high‐risk or all MSM. However, we found that the programme would be approximately 32% more cost‐effective if offered to high‐risk MSM than it would be if offered to all MSM, with an incremental cost‐effectiveness ratio of US$4,836 per disability‐adjusted life years (DALY) averted and US$7,089 per DALY averted respectively. Cost‐effectiveness acceptability curves demonstrate that 80% of scenarios would be cost‐effective when PrEP is provided solely to higher‐risk MSM.ConclusionWe provide the first estimates on cost and cost‐effectiveness of PrEP in the Asia‐Pacific region, and offer insights on how to deliver PrEP in combination with ART. While the high drug cost poses a budgeting challenge, incorporating PrEP delivery into an existing ART programme could be a cost‐effective strategy to prevent HIV infections among MSM in Thailand.

Expansion of HIV Preexposure Prophylaxis to 35 PEPFAR-Supported Early Program Adopters, October 2016–September 2018

“…Novel PrEP delivery mechanisms (e.g., event-driven PrEP and long-acting PrEP injectable drugs) are being explored as alternatives to daily oral PrEP. One study in Thailand concluded that incorporating PrEP delivery into existing antiretroviral therapy programs could be a cost-effective strategy to prevent HIV infection among MSM ( 5 ).…”

“…Most governments supported PrEP programs by drafting policies and guidelines, developing or adapting PrEP training curricula, accrediting sites, and collecting and reporting data. PrEP marketing innovations, including promoting PrEP outside the typical clinical platform through drop-in centers or key population safe spaces; on social media; at meeting places such as sex clubs and gay bars; and in the community through peer outreach also were critical accelerators ( 5 ).…”

Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men

“…74 Analyses of barriers to PrEP implementation at the systems level note that reducing financial burden related to medication is paramount for the feasibility and sustainability of PrEP programs. 75,76 In modeling studies, cost of PrEP medication is a critical factor in shortening the time horizon for the cost effectiveness of PrEP as an intervention. 24,77 And reviews of implementation efforts demonstrate that PrEP rollout is successful when government provides financial support and is impeded when such support is lacking.…”

Building the evidence base to optimize the impact of key population programming across the HIV cascade

“…Finally, Suraratcheda et al . contribute the first estimates on the costs and cost‐effectiveness of providing oral PrEP for MSM in Thailand . Costing studies related to key population programming are extremely limited yet costing data are critical for effective programme planning.…”